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Book review: The parents’ guide to Body Dysmorphic Disorder. How to support your child, teen or young adult

Book authors: Nicole Schnackenberg, Benedetta Monzani and Amita Jassi

What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder (BDD) is thought to affect roughly 2% of the population and is characterised by a distressing preoccupation with “defects” in one’s appearance, that are unnoticeable to others and yet cause clinical levels of anxiety and preoccupation for sufferers.

A common feature of BDD is low insight, meaning that the individual finds it difficult to understand that their self-perception does not align with how others perceive them, leading them to believe they are genuinely physically abnormal or hideous. Repetitive behaviours often occur as attempts to reduce the felt anxiety, most common of which include disguising body parts, seeking reassurance about appearance, mentally comparing oneself to others and ‘checking’, which usually involves examining one’s appearance in a mirror or a camera, sometimes for hours at a time.

At this point, it may be important to note that the label can be misleading, as the site of fixation is most often a facial feature and preoccupation that centres on weight or body fat would not in fact qualify someone for a diagnosis of BDD.

BDD most commonly onsets during early adolescence and unfortunately, it can have a detrimental impact on many aspects of adolescent development, including poor social functioning, severe impairment in academic attainment and high rates of school refusal and school dropout. Sadly, suicide and substance abuse in adolescent sufferers are also not uncommon. Additionally, the common lack of insight is especially severe at this time of life, meaning that the extent to which some teenagers believe they are genuinely physically abnormal can make psychological treatment appear futile to them. This can lead them to instead seek cosmetic surgeries, which research tells us are ineffective for dealing with BDD. 

The above information paints a concerning picture for parents whose children may be suffering with BDD. Fortunately, Nicole Schnackenberg, Benedetta Monzani and Amita Jassi have drawn on their years of experience of researching and treating BDD to write a guide for parents and families in this situation.

Before reviewing the content of this book, it is important to acknowledge just how important it is that it exists at all; BDD is a very misunderstood and under-recognised disorder, despite its high prevalence, and until now, parents and carers have been left wanting for easily accessible information to help them understand and cope with the upheaval that BDD can cause. This book provides just that: a clear, comprehensive and, most importantly, practical guide that incorporates the best available evidence-based approaches for talking about, supporting and treating BDD in young people.

About the book

After giving an informative overview of what life is like for children and young people with BDD as well as their families, the book provides many excellent tips for parents on how to seek and provide effective support. Additionally, it highlights the importance of self-care for parents. Raising a child with any mental health issue is a difficult task. Parents play an important part in their children’s coping with BDD. The book recognises the complexity of the emotions linked with the expectations put on these parents. Remaining positive, maintaining hope and overcoming setbacks is an important part of parents’ ability to be a protective factor on the path of recovery from BDD. 

The book discusses various levels of support that should be provided for children and young people struggling with BDD. The authors highlight that support starts in the home and they list strategies and conversation starters for parents to have a meaningful conversation with their child. Some of these strategies focus on active listening, being non-judgemental and being realistic.

The book then moves on to support through educational settings. BDD can have a severe impact on education. Issues around attendance, school refusal and discontinuing education as well as the factors that play a role in these are discussed. aising awareness for BDD in schools and involving relevant professionals, such as educational psychologists is an important part of the support aimed at improving the school experience of children and young people with BDD

The authors produced a leaflet informed by young people’s narrative. The leaflet aims to show what young people do and do not find helpful in a school environment. It can be downloaded from the BDD Foundation website.

Finally, the authors explore recommended evidence-based treatments for BDD, such as BDD-specific Cognitive Behavioural Therapy with Exposure and Response Prevention as well as antidepressants (SSRIs). The authors provide a good description of what treatment might look like and the way to access it.  

Future revisions of the book can perhaps signpost parents of teenagers who are reluctant to engage with any form of support. As the real-life cases in Chapter 11 (Our BDD Journey) show, some teenagers might refuse parental advice or any form of therapeutic intervention. At this particular life stage, growing independence from parents and decreased engagement with parental advice is not unusual. For parents of disengaged children, signposting might be particularly important. The real-life scenarios show that accessing support might be a long and rocky path filled with difficult conversations and a lot of encouragement. 

The book finishes on a hopeful note highlighting that recovery from BDD is possible and children and young people can go on to live their life to the fullest.    

Our verdict

As Trainee Educational Psychologists we were delighted to come across a book about a little-known condition that we both have personal experience with. It is a very useful resource to share with parents as well as educational settings that might benefit from information around the condition and available support.

Creating more awareness around BDD will hopefully enable parents and school professionals to recognise any signs and promote early intervention. We will certainly recommend this book.   

Find out more about the book

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